Healthcare Provider Details

I. General information

NPI: 1639897838
Provider Name (Legal Business Name): CHRISTIE J JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2561 PLUM CREEK DR
CORDOVA TN
38016-0109
US

IV. Provider business mailing address

2561 PLUM CREEK DR
CORDOVA TN
38016-0109
US

V. Phone/Fax

Practice location:
  • Phone: 901-500-3376
  • Fax:
Mailing address:
  • Phone: 901-500-3376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number000538799
License Number StateTN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: